AB1059 POSSIBILITIES OF COMBINED THERAPY FOR TREATMENT OF HYPERURICEMIA AND ARTICULAR SYNDROME EXACERBATIONS IN PATIENTS WITH GOUT
Authors: V. Tsurko, M. Gromova, O. Kisliak, N. Malysheva
Journal: Annals of the Rheumatic Diseases (2022)

Background Throughout the year 69 per cent of patients with gout experienced repeated exacerbations during therapy aimed at reducing urate levels. Prevention of arthritis exacerbations with low-dose NSAIDs should be done in the first 3-6 months of urate-reducing therapy. Objectives To assess the frequency of exacerbations and quality of life in patients with gout after a 12 weeks course of urate-reducing therapy with allopurinol in combination with the anti-inflammatory drug meloxicam for the prevention of gout exacerbations. Methods Physical examination, сlinical blood, urine tests, biochemical blood tests, instrumental diagnostics were performed in all patients. Information about concomitant diseases was entered, drug therapy was recorded at the time of observation. Allopurinol was administered orally, once a day. Every 3 weeks under the control of serum uric acid levels (sUA), the allopurinol dosage was increased by 50 mg, up to 300 mg per day. The total daily dose of meloxicam administered in different dosage forms was 7.5-15 mg. After 3, 6, 9 and 12 weeks, the clinical effeciency of treatment was assessed using the EuroQol-5D-5L questionnaire, physical examination, joint pain dynamics at rest, during movement and palpation, as well as the Likert scale and visual analog scale (VAS) in mm. Factors such as the presence of anxiety or depression, self-care ability, normal daily activities of daily living were taken into account, as well as their rating of their level of satisfaction with the treatment on a scale of 1 to 5, where 1 is not an improvement but a deterioration and 5 is a very good result. Both the period of remission and the time before the onset of a recurrence of gouty arthritis were taken into account, as well as adverse events (AEs) were recorded. Results 143 patients with an established diagnosis of gout (ACR/EULAR, 2015) were examined at an outpatient appointment. Against the background of treatment with meloxicam 7.5 mg per day, more than two-thirds of the patients did not experience a worsening of the joint syndrome with an increase in the dose of allopurinol to 300 mg per day. By the 12th week of follow-up, it was found that the characteristic features of gouty arthritis significantly began to differ in improving mobility, self-care, habitual daily activities, reducing soreness, reducing anxiety and depression (p &lt;0.05). Moreover, the initial ESR and sUA levels were significantly different from the follow-up endpoint (p &lt; 0.05), indicating a positive effect on the inflammatory process. A three-month course of combination therapy did not cause a significant increase in blood pressure or change in serum creatinine clearance in the patients. From the gastrointestinal tract there were no adverse events. 90.9% of patients assessed the treatment efficiency as very good. AEs in the form of an allergic skin rash were observed in one patient. But there was no need to interrupt the treatment, as the rash completely disappeared without consequences after completing the course of treatment with allopurinol and meloxicam. Conclusion A 12-week combination therapy with allopurinol, a urate-reducing drug, and meloxicam, an anti-inflammatory drug, prevents exacerbation of joint syndrome and improves quality of life in patients with gout. Disclosure of Interests None declared